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Acute type A aortic dissection (AAAD) is a surgical emergency with high operative mortality. Distal propogration of the dissecting flap can lead to malperfusion of territory supplied by the aorta including axillary and brachial arteries causing ischaemia of the upper limb. We present a case of a 67 year old gentleman who had AAAD and developed upper limb malperfusion after repair. Despite adequate repair, the residual dissecting flap propagated distally in the upper arm vasculature causing thombosis of the brachial artery. The patient
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